Perspectives on Organizational Culture in Healthcare

Over the past 30 years, the term organizational culture has gained prominence and have stimulated plenty of interest. Theories have been developed, definitions abound and debates have spurred. Today we still talk about how (and if) one can change organizational culture.  

And “whether managers think that the culture is too soft or too complicated to bother about or whether there is no unique corporate culture does not reduce the significance of culture” (Alvesson, 2002).

“Culture isn’t everything” says a title that caught my eye. The article mentions that even though it's difficult, culture is something that can be enforced. One of two perspectives on organizational culture developed by Smircich (1983) - "culture as a variable"- implies that culture is something the organization "HAS". In essence, it implies that organizational culture needs to be viewed as a tool for enhancing organizational effectiveness. Hence, the existence of "strong culture organizations" that are highly effective (Google, Southwest Airlines, Nordstrom, Westjet).

Coalitions in Healthcare: The Super Power of Pathways

"…then a nurse was telling me how they encountered a problem and how they fixed it…and I said 'No! Don’t do that way!'"* 

These are the words of Paul Levy, former CEO of Beth Israel Deaconess Medical Centre in Boston. His leadership style during the restructuring of BIDMC is studied in organizational behavior courses in postgraduate schools to illustrate decision-making and change management skills. But why would he be against local, grass-root level implementation of changes?

Your Input Matters: Improving Opinion Surveys

If you work in an organization - any organization - you probably received periodical emails with links to opinion surveys. The email message would say something like "your opinion is valued" or "your input matters" and kindly asks you to take few minutes of your day to complete a survey. So what do you do? Click on the survey link? Postpone to action on it? Or simply ignore- or even delete the email?

Questions on Quality: Sail or Sink?

Quality in healthcare: we talk about it, debate about definitions, wonder if we can and if we do measure it. For some of us, it’s an intricate concept that feels like it could make your head explode. For others, it’s common sense: to give the best care, to the right patient, at the right time. 

If it is true that all good things (i.e. Danish-sounding ice-cream) come in small packages…can we at least hope that quality in healthcare comes in cargo loads? Or are we bound to provide healthcare on islands of excellence in a sea of mediocrity?

I will not use this space to expand on the "quality" etymology or on matters of semantics. Instead, I would like to focus on 3 areas related to quality that I came across in discussions and readings this week:

On Revolutions, Rebels and Reshaping Healthcare

In a world of constant change, transforming healthcare is a topic that receives considerable attention. We talk about how we can improve, what solutions to adopt and how to implement change. Then we find ourselves trying to sustain the changes and we go back again to the drawing board: a continuous PDSA cycle within an infinity Enso circle.  This is the fight: against the status quo, to protect our ethical principles as healthcare providers. Our passion guides us like a flag into a war. But is a revolution necessary? Who are the rebels and what do they do?

Say Yes to Engagement!

 

Love is in the air...but not as much in hospitals. Let's talk about it, it is called engagement. And by engagement I mean nurses' work engagement, or more generally, healthcare provider engagement. It is a topic that surprisingly is still poorly actioned on, although research suggests it is an important issue in health services.

It is estimated that as many as 25% of nurses suffer from burnout (this is an estimate in a population of European nurses), and the prevalence of burnout among both doctors and nurses is on the increase (2006 study). Over the last few years, there has been a shift in focus, from "burnout literature" to an alternative movement of "positive psychology". This focus gives more attention to human strengths and optimal functioning rather than to their deficits, so rather than focusing on burnout, the idea is to find ways of increasing the positive consequences for people at work.

Recent research also support the findings of Maslach and Leiter, who identified six areas of organizational life that are crucial in the development of burnout:

The Value of Thanking Employees

Last week was the Perioperative Nurses Week. With this occasion, the nurse educators on our unit prepared a series of short events each day, to show appreciation and motivate nurses: from a pledge board, to photos and presentations and even a chocolate fondue! Of course, all these events were possible with the educators' involvement; they brought their own kitchen gadgets, used their time to put everything together and ensure staff is having fun. We all know that healthcare is one of those areas where funds are limited (or inexistent). While this effort is laudable, I was wondering: where is the management? Peer appreciation is great, and it does make one feel great. But how about appreciation from our leaders and management? Why is that so rare and how important is that to the frontline staff?

It appears that actually, two of the top actions that employers can do to value staff are actually...free! Praise from managers and attention from leaders are followed by opportunities to lead. In healthcare, being recognized by your direct manager can make a huge difference. And surprising enough (for those who believe people are only motivated financially), a whopping 78% of employees would work harder if they would be recognized! I can only imagine what this would do on any unit. The nursing profession is based on a deep personal value, of helping people. Because ultimately, team members who feel poorly regarded by the leader are going to have the human propensity to remain disconnected from the leader and the common goal (J. Nance, Why hospitals should fly). 


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Shifting Culture in Healthcare

It is a fascinating idea, and it is (and will be) proved to be successful: implementing a new way to achieve better healthcare. From Tommy Douglas to Lean, Saskatchewan ran already a multitude of processes to improve healthcare (listen to podcast here). There is also debate on implementing Lean in healthcare, and many are also skeptical on the results. So how do we shift culture in healthcare?

People have to look at the processes from a patient's perspective, and whether you call it Lean, 4Dx or something else, this will not change the basic idea, that the ultimate person of interest is the patient (and not the physician). Removing waste, removing what is of no value and shift your viewpoint will ultimately make a difference. Sadly, leadership and healthcare management want to 'kill the mosquitoes' , without 'draining the swamp'. That means assigning a person to 'do the improvement work', and come back and report (while being held accountable for failures). But the data out there- and the examples from many Lean organizations- prove that improvement without senior management involvement is difficult, if not impossible to achieve long term.

My opinion on culture shifting: start talking about improvement, talk about tools and what is being done out there. Make nurses aware that they have power to improve their workplaces, and encourage involvement. Healthcare improvement happens everywhere in the world, and it is a real movement, not a fad. We can slow it down, but we can't stop it. So you are either be prepared, or find yourself on a burning platform!